Excellent question! You essentially have 3 main variations on the theme when purchasing ObamaCare compliant major medical insurance;
1) Conventional plan designs with office visit & prescription copays and lower deductibles (pretty pricey these days)
2) High deductible health insurance plans designed to work with a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA) - becoming more common.
3) Plans that fall in between, here you may see a plan with office visit copays and a high deductible applying to everything else, plans with prescription copays and a high deductible applying to everything else, or plans with more moderate deductible levels with all services subject to the plan's deductible and co-insurance requirements but that also don't meet the IRS requirements for being an HSA eligible plan.
Simple, right? First, determine if the doctors, hospitals and pharmacies you want to use are in-network providers for the plan you are interested in. Second, review you health and your history of health care consumption. Your needs and usage at 27 will probably be much different than when you are 47. Try to pick a plan that you believe will meet your needs in the coming year at the best value.
Determine if the plan you are interested in allows for direct access to specialists or whether it requires you to be referred out by your primary care physician first. Neither approach is bad but you should understand how you are supposed to access care in order to maximize your benefits and minimize your costs. Ask what your coverage is when you are outside of your immediate area. Increasingly you may find that you only have emergency care outside of a plan's "service area" or perhaps no coverage at all.
Do you have special needs? A chronic illness or injury that requires ongoing treatment or expensive prescription medication requires extra homework. For example, some health plan's pharmacy benefits cover HIV/AIDS medications at the lowest level (to them, highest for you) possible.
Finally, compare monthly premiums. The lowest monthly cost, while always attractive, many not really be the lowest annual cost for you once you factor in some or all of the issues I have pointed out above. It may be worth another $50 a month in premiums to have a prescription copay instead of a deductible of up to $6300 to meet before your expensive medication is covered.
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1) Conventional plan designs with office visit & prescription copays and lower deductibles (pretty pricey these days)
2) High deductible health insurance plans designed to work with a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA) - becoming more common.
3) Plans that fall in between, here you may see a plan with office visit copays and a high deductible applying to everything else, plans with prescription copays and a high deductible applying to everything else, or plans with more moderate deductible levels with all services subject to the plan's deductible and co-insurance requirements but that also don't meet the IRS requirements for being an HSA eligible plan.
Simple, right? First, determine if the doctors, hospitals and pharmacies you want to use are in-network providers for the plan you are interested in. Second, review you health and your history of health care consumption. Your needs and usage at 27 will probably be much different than when you are 47. Try to pick a plan that you believe will meet your needs in the coming year at the best value.
Determine if the plan you are interested in allows for direct access to specialists or whether it requires you to be referred out by your primary care physician first. Neither approach is bad but you should understand how you are supposed to access care in order to maximize your benefits and minimize your costs. Ask what your coverage is when you are outside of your immediate area. Increasingly you may find that you only have emergency care outside of a plan's "service area" or perhaps no coverage at all.
Do you have special needs? A chronic illness or injury that requires ongoing treatment or expensive prescription medication requires extra homework. For example, some health plan's pharmacy benefits cover HIV/AIDS medications at the lowest level (to them, highest for you) possible.
Finally, compare monthly premiums. The lowest monthly cost, while always attractive, many not really be the lowest annual cost for you once you factor in some or all of the issues I have pointed out above. It may be worth another $50 a month in premiums to have a prescription copay instead of a deductible of up to $6300 to meet before your expensive medication is covered.